U.S. pilot plan covers curative treatment, hospice services both for terminally ill

Patients with terminal illnesses may no longer have to forgo aggressive treatments in order to be eligible for comfort care under a new government pilot.

The idea of providing hospice and curative care at the same time has been mulled over for a while. It’s outlined in the Affordable Care Act, and some private insurers have been experimenting with it. But, in general, the services are not covered simultaneously.

So patients with advanced stages of cancer, lung and heart disease often face a difficult choice when outside the hospital: continue with treatments such as chemo or drop it and go with services for symptom management and psychosocial support.

For many, choosing hospice over aggressive treatment can be really scary, said Anthony Bolden, director of Compassionate Care Hospice in South Jersey. It can seem like they’re giving up.

But it means that a lot of patients postpone important care and suffer and unnecessarily.

“They’re not having their physical symptoms managed, they’re not having their spiritual symptoms managed and their emotional pain,” said Bolden.

This week, the Centers for Medicare and Medicaid selected 140 hospice groups — including Bolden’s — to take part in a pilot that will reimburse providers for both types of care.

Other initiatives, such as those led by Dr. David Casarett at the University of Pennsylvania, have found that patients who can get comfort care while continuing with aggressive treatments experience improvements in pain management and quality of life. It can even reduce health care costs.

But Casarett said he worries about the sustainability of this new pilot, given its limited funding. The hospice agency he directs didn’t apply.

“The idea that we need a program like this is absolutely spot on target,” said Casarett. “The challenge, though, is that we’ve learned that to provide services these patients need costs anywhere from $30 to $40 a day.”

Participating groups in this new “Medicare care choices model” will receive $200 to $400 a month per patient. While Bolden agreed the payments are low, he doesn’t think all patients will need a high level of care. He’s hoping the model will help reduce patients’ fears about hospice, so they can experience the benefits.

The pilot starts in January and is being rolled out over the next few years.

Other participating agencies from New Jersey, Delaware and Pennsylvania include:

Delaware Hospice, Inc. – Southern Division (Delaware)
Delaware Hospice, Inc. – Central Division (Delaware)
Hospice and Community Care (Pennsylvania)
Hospice of Central Pennsylvania (Pennsylvania)
Jewish Association on Aging dba Sivitz Jewish Hospice (Pennsylvania)
Neighborhood Visiting Nurse Association dba Neighborhood Health (Pennsylvania)
Compassionate Care Hospice of Marlton dba Compassionate Care Hospice (New Jersey)
Meridian Home Care Services Inc. dba Meridian Hospice (New Jersey)
Robert Wood Johnson Visiting Nurse, Inc. (New Jersey)
Visiting Nurse Association of Central Jersey Hospice (New Jersey)
Visiting Nurse Association of Englewood Hospice (New Jersey)